Fugl-Meyer Assessment

Abstract

The Fugl-Meyer Assessment (FMA) is a widely recognized, standardized performance test used primarily in rehabilitation settings to evaluate and measure motor function, balance, sensation, and joint function in patients who have suffered a CVA (stroke). It is designed to quantify the severity of impairments in functional domains.

The complete assessment involves 55 distinct test items, which are scored using an ordinal 3-point scale (0, 1, or 2). While the comprehensive FMA covers the upper extremity, lower extremity, and balance, clinical practice often focuses on the motor components, as the balance items may not offer significant added value compared to dedicated balance assessment tools.

Keywords

Fugl-Meyer Assessment, FMA, Stroke, CVA, Motor recovery, Neurological assessment, Performance test, Rehabilitation, Upper extremity, Lower extremity, Mobility.

Authors

Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Svardsudd K (1975); Dutch adaptation by KNGF-richtlijn Beroerte (2004).

Purpose

The primary purpose of the FMA is to provide a reliable and objective measure of motor and sensory impairment severity following a stroke. It serves as a crucial tool for therapists and researchers to track patient recovery over time, evaluate the effectiveness of interventions, and classify patients based on their level of motor function.

It specifically focuses on observing the recovery stages of movement control, often reflecting the Brunnstrom stages of motor recovery, thereby aiding in prognostication and treatment planning in the acute and chronic phases of post-stroke rehabilitation. The scale assesses functions related to Mobility/movement and Sensorische functies en pijn (Sensory functions and pain).

Construct

The FMA measures the construct of post-stroke physical impairment, encompassing several key domains: motor function (which contributes the largest score), sensory function, balance, joint range of motion, and joint pain. The motor component is particularly focused on quantifying synergy-dependent and synergy-independent movements, reflecting the neurological damage caused by the CVA.

The scale’s structure reflects the belief that motor recovery progresses through specific stages, moving from reflexive, synergistic movements toward isolated, voluntary control. The FMA provides a quantitative score for this progression, making it a key indicator of neurological recovery rather than just functional independence.

Validity

The FMA demonstrates robust criterion and construct validity. It shows strong correlation with other established measures of post-stroke impairment and disability, such as the Modified Rankin Scale and the National Institutes of Health Stroke Scale (NIHSS). This indicates that the FMA accurately measures the severity of impairment it intends to assess.

Content validity is ensured by the fact that the items were derived from clinical observations concerning typical patterns of neurological motor recovery after a CVA. Furthermore, the scale exhibits sensitivity to change, meaning it can effectively capture clinically meaningful improvements in motor function over the course of rehabilitation, a critical psychometric property.

Reliability

The FMA is considered highly reliable. Numerous studies have confirmed its excellent inter-rater and intra-rater reliability, particularly for the motor subscales (upper and lower extremity). This high reliability suggests that results are consistent regardless of the administrator or repetition of the test under stable conditions.

Internal consistency, which measures how well the items within a subscale relate to each other, is also generally very high, supporting the notion that the various items within the motor subscales are measuring a single, unified construct of motor impairment.

Factor Analysis

Factor analysis of the FMA often supports the segregation of the scale into distinct dimensions, confirming the original theoretical structure. Typically, analyses confirm separate factors for the Upper Extremity Motor Score and the Lower Extremity Motor Score.

More detailed analyses sometimes reveal sub-factors within the motor domains, differentiating between movements that are synergistic (dependent) versus those that are isolated (independent). These findings reinforce the FMA’s utility in assessing specific components of neurological motor control recovery.

Instrument

Test Type: Observational Performance Test.

Format: 55 items scored on an ordinal 3-point scale (0 = cannot perform, 1 = performs partially, 2 = performs fully).

Language Available: Original English; Dutch version available (KNGF-richtlijn Beroerte).

Population Group: Adults and Older Adults.

Age Group: Typically utilized for individuals aged 18 and older (Volwassenen, Ouderen).

Population Details: Patients diagnosed with a CVA (stroke) or other neurological conditions affecting mobility and sensory functions. Focuses on assessment of the nervous system and senses.

Test Methodology: The FMA is a structured, standardized examination requiring the patient to perform specific movements and tasks. It measures impairments related to mobility, movement, sensory functions, and pain, specifically targeting the upper and lower extremities. The original PDF documentation for the Explanation Form can be downloaded here: FMA Explanation Form PDF. The original PDF documentation for the Measurement Instrument can be downloaded here: FMA Measurement Instrument PDF.

Keywords

Motor recovery, Neurological assessment, Psychometric properties, Rehabilitation outcome, Physical impairment, Balance assessment, Joint function, Sensory function, Performance assessment.

Authors

Author ORCID Identifier: Information not available in source.

Affiliation Email addresses: Information not available in source.

Correspondence Address: Information not available in source.

Permissions & Fee and Test Year

Test Year: 1975 (Original publication).

Permissions and Fee: The FMA is generally considered a clinical instrument widely used in research and practice, often available without direct per-use fees, though specialized training is required for reliable administration. Users should consult the original authors or relevant national guidelines (e.g., KNGF for the Dutch version) regarding official usage permissions.

Reference’s

Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Svardsudd K. The post-stroke hemiplegic patient. A method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.

KNGF-richtlijn Beroerte (2004). Nederlandse versie van het Fugl-Meyer Assessment. Koninklijk Nederlands Genootschap voor Fysiotherapie.

Items of the Fugl-Meyer Assessment

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way. Note that the source material provided the structure of the assessment but not the specific 55 test items themselves.

The Fugl-Meyer Assessment is composed of 55 items and originally encompassed the following domains:

• Motor function of the upper extremity (shoulder, elbow, forearm, wrist, hand).
• Motor function of the lower extremity (hip, knee, ankle).
• Balance (often excluded in clinical practice).
• Sensory function (light touch, position sense).
• Joint range of motion and pain.